LES ACTIVITÉS NUCLÉAIRES : RAYONNEMENTS IONISANTS ET RISQUES POUR LA SANTÉ ET L’ENVIRONNEMENT 2.4 Fluoroscopy-guided interventional practices Fluoroscopy-Guided Interventional Practices (FGIPs) group all the imaging techniques using ionising radiation for the purpose of imaging, guidance or verification, for performing invasive medical or surgical procedures for diagnostic, preventive or therapeutic purposes. The practices are therefore based on the use of realtime radiological imaging to guide precise and mini-invasive medical operations. Today it is possible to treat patients previously considered inoperable or who required major surgical operations. The patients thus benefit from less traumatic procedures with shorter recovery times and lower risks of complications. These medical practices have been evolving constantly for several years now, and are used for an ever-increasing number of pathologies, providing opportunities for new therapeutic and diagnostic possibilities. Due to their interventional nature, these procedures are carried out in two separate environments – either operating theatres or interventional imaging departments – depending on the target and the pathology. Fixed interventional radiology rooms have been designed and fitted out to include the use of ionising radiation, which is not yet the case for all operating theatres. On account of the exposure levels involved, both for patients and for professionals who may be required to work close to equipment emitting ionising radiation, and the increase in the number of procedures performed using ionising radiation, FGIPs and, in particular, operating theatres, due to a less well-developed radiation protection culture, are part of ASNR’s national inspection priorities. 11. Form that the centres had to fill out with the information requested in paragraph I of article 12 of ASN resolution 2021-DC-0704 relative to the registration system in the medical field "For fluoroscopy-guided interventional practices having been notified to ASN, a description of the types of procedures performed in accordance with the list figuring in article 1 (of the resolution), and the references of the notification concerned, must be submitted within twelve months following entry into effect of this resolution (before 1 July 2022). 2.4.1 – Description of the techniques The healthcare centres According to the codes of the common classification of medical procedures and the activity data notified by the healthcare centres to the Agency for Information on Hospital Care (AIHC), about 900 centres perform FGIPs involving risks with regard to radiation protection in one or more disciplines. The risk-prone FGIPs include cardiology (implanting pacemakers and defibrillators, angioplasty, etc.), interventional neurology (embolization of arterioveinous malformation), vascular radiology (embolization of the coeliac artery), or uterine embolization. Graph 10 shows the breakdown of the number of centres by FGIP category for the centres having declared the FGIPs they practice(11). Based on available information, the most widely practised procedures in the centres are those performed on the digestive and visceral system, in urology, and on the musculoskeletal system (some 450 centres concerned). The equipment The equipment items used in FGIPs are either fixed C-arm devices installed in the interventional imaging departments in which vascular specialities (neuroradiology, cardiology, etc.) are carried out, or mobile C-arm radiology devices used chiefly in operating theatres in several surgical specialities such as vascular surgery, gastroenterology, orthopaedics and urology. The detectors present on the devices with C-arms are image intensifiers or flat panel detectors. These devices employ techniques that use fluoroscopy and dynamic radiography (called “photofluorography”, or “cineradiography”) intended to produce images with high spatial and temporal resolution. Practitioners can also use the subtraction method to obtain images, after injecting a contrast agent. A growing number of manufacturers are developing new innovative technologies with increasing use of Artificial Intelligence (AI). The centres practising FGIPs are equipped with Summary The inspections carried out in 2025 in more than a quarter of nuclear medicine departments, considered alongside those conducted during the period 2020–2024 and covering the entire stock of facilities, confirm a satisfactory situation, while also highlighting points requiring particular attention. Radiation protection for workers is well established in this area, with the exception of two weaknesses, namely the implementation of checks on workplaces and work equipment and the formalisation of interventions by personnel from outside the nuclear medicine departments. Dosimetric monitoring of workers, while at a good level, must remain a point requiring particular attention in the context of the emergence of new practices, as must the training of professionals, which still shows room for improvement over the period 2020–2025. The 2025 inspections confirmed, as in previous years, that particular attention must be paid to compliance with the regulatory provisions on effluent management (in particular, checking that the alarms on the decay tanks are working and that they are set to operate during non-working hours) and on waste generated by patients at home. The latter, linked to the emergence of new RPDs, can cause radiation portal monitors at the entrance to waste processing sites to be triggered. With regard to patient radiation protection, implementation of the principle of optimisation with the collection and analysis of DRLs has continued to improve over the period 2020-2025. The deployment of QSMSs is continuing, although more unevenly across departments, as is the quality of ESR identification and analysis. Once again this year, ESRs show that the processes for preparing and administering medicines are not consistently controlled across all departments, as illustrated by errors in identity monitoring and in the use of dose calibrators. These practices require regular training, refresher sessions and assessment to ensure that they remain properly mastered over time (see the bulletin “Safety of the medication circuit in nuclear medicine”). In addition, measures to prevent the risk of extravasation and to treat patients if such a situation arises, must be defined in all the departments because these situations can lead to significant exposure at the injection site, particularly in the case of ITR treatment. The major challenges associated with the development of nuclear medicine for patients and their families, professionals, the public and the environment, arising from the growing number of clinical trials involving new vectors and radionuclides (lutetium-177, actinium-225, etc.), highlight the need to address these issues in a comprehensive manner and to support these developments. The commitment and collaboration of all stakeholders (inspection agencies, manufacturers, sponsors, investigators, healthcare providers and professional associations) are essential to enable innovation to develop within a safe framework for the benefit of patients. From the end of 2025, ASNR has adapted its licensing process to make it easier for centres to take part in clinical trials. It will take a position in 2026 on the basis of a GPRP opinion setting out recommendations for improving radiation protection in clinical trials involving radionuclides. ASNR Report on the state of nuclear safety and radiation protection in France in 2025 213 01 05 02 03 04 09 06 10 07 11 13 08 12 A / Z
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